2Division of General Medicine, Department of Medicine, University of Texas at Houston, Memorial Hermann Center for Healthcare Quality and Safety, University of Texas Medical School
at Houston, Houston, Texas, USA

Abstract

Background The frequency of outpatient diagnostic errors is challenging to determine due to varying error definitions and the need to
review data across multiple providers and care settings over time. We estimated the frequency of diagnostic errors in the
US adult population by synthesising data from three previous studies of clinic-based populations that used conceptually similar
definitions of diagnostic error.

Methods Data sources included two previous studies that used electronic triggers, or algorithms, to detect unusual patterns of return
visits after an initial primary care visit or lack of follow-up of abnormal clinical findings related to colorectal cancer,
both suggestive of diagnostic errors. A third study examined consecutive cases of lung cancer. In all three studies, diagnostic
errors were confirmed through chart review and defined as missed opportunities to make a timely or correct diagnosis based
on available evidence. We extrapolated the frequency of diagnostic error obtained from our studies to the US adult population,
using the primary care study to estimate rates of diagnostic error for acute conditions (and exacerbations of existing conditions)
and the two cancer studies to conservatively estimate rates of missed diagnosis of colorectal and lung cancer (as proxies
for other serious chronic conditions).

Results Combining estimates from the three studies yielded a rate of outpatient diagnostic errors of 5.08%, or approximately 12 million
US adults every year. Based upon previous work, we estimate that about half of these errors could potentially be harmful.